Postexposure treatment of rabies in Pakistan

To evaluate compliance with current World Health Organization (WHO) guidelines for postexposure treatment (PET) of rabies, we interviewed all animal bite victims seeking treatment on the same day of each week from 28 December 1994 through 18 January 1995 at the Civil Hospital of Karachi (Pakistan), a major referral center. Of the 143 patients studied, 109 (76%) sustained bleeding transdermal bites (WHO category III). Overall, wounds were not washed with soap or an antiseptic in 69% of victims. All victims received 5% sheep brain-derived vaccine, and only three of the 109 victims with category III bites received rabies immune globulin. PET of rabies in Karachi was deficient by all WHO standards. Although there is a great urgency to improve PET, it will remain a costly and inefficient method of controlling rabies. Reduction of rabies reservoirs is required to decrease human deaths due to rabies in Pakistan and other developing countries in which canine rabies is endemic.     

Postexposure prophylaxis after nonoccupational HIV exposure: clinical, ethical, and policy considerations

In the wake of recent breakthroughs in antiviral therapies and Centers for Disease Control and Prevention (CDC) recommendations advocating occupational postexposure prophylaxis (PEP), health care workers are increasingly receiving inquiries about PEP following exposures to the human immunodeficiency virus (HIV) through sex and injection drug use. The probability of HIV transmission by certain sexual or injection drug exposures is of the same order of magnitude as percutaneous occupational exposures for which the CDC recommends PEP. In such cases, if the exposure is sporadic, it seems appropriate to extrapolate from the data on occupational PEP and recommend prophylaxis. However, for individuals with continuing or low-risk exposures, we instead recommend referrals to state-of-the-art risk reduction programs. Clinicians, using local HIV seroprevalence data and their knowledge of transmission probabilities, can help exposed patients make an informed decision regarding PEP. Because of the large number of risky encounters that will not be treated prophylactically, even after significant outreach efforts, public health interventions that emphasize PEP as part of a comprehensive HIV prevention program should be confined to cities with highest HIV prevalences.     

Postexposure treatment with aminophylline protects against phosgene-induced acute lung injury

Our model of the human m1 muscarinic receptor has been refined on the basis of the recently published projection map of bovine rhodopsin. The refined model has a slightly different helix arrangement, which reveals the presence of an extra hydrophobic pocket located between helices 3, 4 and 5. The interaction of series of agonists and antagonists with the m1 muscarinic receptor has been studied experimentally by site-directed mutagenesis. In order to account for the observed results, three-dimensional models of m1 ligands docked in the target receptor are proposed. Qualitatively, the obtained models are in good agreement with the experimental observations. Agonists and partial agonists have a relatively small size. They can bind to the same region of the receptor using, however, different anchoring receptor residues. Antagonists are usually larger molecules, filling almost completely the same pocket as agonists. They can usually produce much stronger interactions with aromatic residues. Experimental data combined with molecular modelling studies highlight how subtle and diverse receptor-ligand interactions could be.     

Current treatment of HIV infection

The treatment of HIV infection in the industrialised countries has undergone manifest changes during the past decade. Since the advent of zidovudine in 1987, the first agent capable of delaying disease progression, several other nucleoside analogues have been introduced, though in retrospect the effect of these drugs can now be seen to have been moderate. With the introduction of proteinase inhibitors, more effective control of infection became possible, and the combination of a proteinase inhibitor with two nucleoside analogues yielded a triple-drug treatment capable of halting progression for a large proportion of patients. Thus, during recent years the disease course has changed in character from successive deterioration of the immune defence system to a condition where most patients can live virtually normal lives in many respects. For some patients, however, the new drugs have been associated with side effects, and our knowledge of the long-term effects is still insufficient.     

Stimulant abuse treatment as HIV prevention

In the past several years, the greatest proportionate increase in AIDS diagnoses has occurred among women. Yet, while the risk of HIV infection increases, female college students continue to report inconsistent HIV prevention behaviors. Past research on condom use among college women has focused on intrapersonal aspects of the behavior, and little is known about the influence of interpersonal factors on women's condom use. In this study we examined the relative salience of both intra and interpersonal factors on African American and white women's use of condoms. We found that interpersonal variables were particularly salient predictors of condom use. There were no ethnic differences in the effects of interpersonal variables; however, there were differences in the effects of self-efficacy on condom use.     

Outcome Pre- and Postexposure Effects: Retention Interval Interacts With Primacy and Recency.

Effects of outcome-alone pretraining and posttraining exposure were investigated in conditioned suppression experiments conducted within a sensory preconditioning preparation with rats. Experiment 1 found that interference by outcome postexposure was stronger than that by outcome preexposure, suggesting a recency effect. Experiment 2 found that after a long retention interval, outcome preexposure produced more interference than outcome postexposure, suggesting a shift from recency to primacy with increasing retention interval. Experiment 3 showed that presentation of a priming stimulus that had been embedded within the earlier phase of treatment also caused a shift from recency to primacy. These results suggest that, at least in a sensory preconditioning paradigm, retrievability of outcome-alone exposure memory is an important determinant of any outcome-alone exposure effect. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Occult HIV infection: diagnosis and treatment of older patients

The decrease in immune status that accompanies normal aging leaves individuals age 50 and older increasingly susceptible to the two main modes of HIV infection: sexual activity and blood transfusions. Although therapy for older HIV patients is essentially the same as for younger patients, knowledge of appropriate drug dosages and nutritional issues that influence the care of the older HIV patient is essential for physicians treating this population. Physicians need to recognize the clinical features of HIV-related dementia and opportunistic infections that distinguish it from other age-related illnesses such as Alzheimer's and Parkinson's disease. Known risk factors that affect older patients should influence physicians to routinely include HIV in their differential diagnoses.     

Complex HIV treatment regimens and patient quality of life.

Recent advances in the treatment of HIV/AIDS have led to medical improvements for persons living with the virus. As a result, many now think of HIV infection as a chronic rather than a terminal illness. Along with this shift comes the understanding that individuals now live with treatments that require long-term adherence to regimens that are often complex, time consuming, and not without deleterious side effects. The greater life expectancy, nature of new treatments and their dependence on regimented adherence has recently led to the investigation of psychosocial variables loosely categorized as quality of life (QOL). Although there has been relatively little research on the topic in relation to new HIV therapies, what is known is that QOL--with all of its complications and dimensions--appears to play an essential role in HIV and HIV treatment. Moreover, QOL would seem to be a most worthwhile component to further investigations of improved therapies and betterment for the lives of infected individuals. The following literature review discusses these issues, highlights key research findings, and provides directions for further research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Readmissions to drug abuse treatment and HIV risk behavior

The objectives of the study were (a) to investigate the characteristics of drug abuse treatment clients who return to treatment and (b) among those with readmissions, to describe changes over time in risk behavior for human immunodeficiency virus (HIV) infection and to identify factors associated with behavior change. Data were derived from a multisite HIV surveillance program in a single community; the program used a unique identifier to link HIV test results and behavioral information from multiple contacts. During a 30-month period, 1994 clients were admitted to three satellite facilities of a single treatment agency: detoxification, long-term residential, and outpatient. Of these clients, 574 (29%) had one or more readmissions to the same or a different facility during the 24 months following the index admission. Drug injectors, those tested for HIV, and those living in the community were more likely to be readmitted to treatment. There was little overall change in HIV risk behavior between the index admission and the readmission furthest in time from the index admission. Clients whose index visit was at the residential facility were more likely to reduce their injection risk behavior than those admitted to the other facilities. Clients readmitted to either the residential or the outpatient facility were more likely to have reduced their injection risk behavior than those readmitted to detoxification. Treatment facility was not associated with sexual risk behavior change. Men were more likely than women to reduce their high-risk sexual behaviors. The results underscore the need for treatment programs to make HIV testing readily available to their clients and to make special efforts to assist female clients to reduce their HIV risk.     

Meta-analysis of HIV risk-reduction interventions within drug abuse treatment programs.

A meta-analysis was conducted on studies using a treatment-comparison group design to evaluate HIV/AIDS risk-reduction interventions for clients enrolled in drug abuse treatment programs. Overall, the interventions studied were found to have a reliable positive (weighted) effect size (d?=?0.31), and this was unlikely to be due to publication bias. Effect sizes for specific categories of outcome variables were 0.31 for knowledge, attitudes, and beliefs; 0.26 for sexual behavior; 0.62 for risk-reduction skills; and 0.04 for injection practices. A number of potential moderators were examined. Effect sizes were negatively correlated with the presence of predominantly ethnic minority samples and positively correlated with the number of intervention techniques used, the intensity of the intervention, intervention delivery at a later stage of drug treatment or within methadone treatment, and the presence of a number of specific intervention techniques. (PsycINFO Database Record (c) 2010 APA, all rights reserved)